Major changes needed for autism, ADHD and mental health care, review says

The Independent Review into Mental Health Conditions, ADHD and Autism, chaired by Professor Peter Fonagy, recommends moving towards a needs-led approach in which patients can access appropriate support before, during and after diagnostic assessment, rather than having to wait for a formal diagnosis.

The review found that more than 800,000 people in England were waiting for autism or ADHD assessments at the end of 2025, highlighting the pressures facing both primary care and specialist services.

It also raised concerns about the quality and consistency of diagnostic assessments, the growing overlap between mental health and neurodevelopmental presentations, and gaps in post-diagnostic support.

Currently, 61% of 16- to 24-year-olds experiencing a common mental health condition also screen positive for autistic traits and 57% for ADHD symptoms. In addition, if current trends continue, by 2030 over 4.5 million children and young people could suffer from “high psychological distress”.

Factors such as uncertainty around housing, employment and finances, greater educational pressures, social media and loneliness are together contributing to a substantial increase in mental health problems and self-harm.

What could this mean for clinical practice?

For GPs and other healthcare professionals, the recommendations raise important questions about how patients with suspected autism, ADHD or co-occurring mental health difficulties are assessed, supported and referred.

The review argues that clinical services should move beyond diagnosis as the primary gateway to care, with greater emphasis on identifying functional difficulties, providing timely interventions and ensuring that specialist assessment and treatment remain accessible to patients with complex or enduring needs.

It also called for better national data collection on people with the most intensive support needs to ensure they are not overlooked in future service planning.

Growing crisis in children’s mental health

The Royal College of Paediatrics and Child Health said that the findings mirror what paediatricians are seeing on the frontline, which is painting a stark picture of a growing crisis in children’s mental health and long waiting times for neurodevelopmental services. Demand for assessment, diagnosis and treatment has reached unprecedented levels, leaving far too many children facing long waits for support.

RCPCH Officer for Health Services, Dr Ronny Cheung, said: “Too often, a diagnosis is the only route to accessing meaningful help. This means that children and families can be left struggling alone while waiting for assessments, with little or no support available in the meantime. We therefore welcome the Fonagy review’s recommendation for a needs-led plus diagnosis model of care, which would enable children to receive support based on the challenges they are facing, rather than having to wait for a formal diagnosis.

“Moreover, the review’s recommendation of moving to a singular service for neurodevelopmental and mental health assessment and support will ensure children and young people can seamlessly and more quickly access a robust, holistic and reliable standard of care.

“These measures would be important steps towards improving children’s wellbeing and ensuring that need is identified appropriately, and support is available when it is needed most. However, it must be accompanied by sustained investment in diagnostic and specialist services, which remain essential to providing timely, high-quality care for children and young people.”

Findings from autism, ADHD and mental health review

There has been a 20-fold jump in the number of six- to 11-year-olds being diagnosed with autism between 2000 and 2025, and in 12- to 17-year-olds there has been a 40-fold jump. The report added that there was a 15-fold increase in recorded ADHD diagnoses among teenagers since 2000.

However, the review found that rising diagnosis rates do not necessarily reflect a corresponding increase in the underlying prevalence of the condition, highlighting the role of improved recognition and growing demand for assessment.

The reviewers said that the heated debate about whether there is too much diagnosis or too little risks reinforcing the centrality of diagnosis rather than need and timely access to support and treatment. Therefore, the government should address two failures at the same time: people wait far too long for support, diagnosis and treatment, and diagnosis has become the primary gateway to support that could and should be available earlier.

What was the aim of the review?

The review was commissioned by former Health Secretary Wes Streeting to understand why many people who are autistic, have ADHD, and/or experience mental health conditions are not getting the support they need as quickly or as early as they need it, and what needs to change to address this.

It was chaired by Professor Peter Fonagy, Head of the Division of Psychology and Language Sciences at UCL, supported by Professor Sir Simon Wessely, Professor of Psychiatry at the Institute of Psychiatry and Neuroscience at King’s College London and Professor Gillian Baird, a leading autism expert and Chairman of the British Academy of Childhood Disability, as vice-chairs.

An interim report was published in June of this year, setting out key findings from the data and evidence reviewed so far, and plans for the next phase of the review. It found that the pressure currently being experienced across mental health and neurodevelopmental services is substantial and well evidenced, but could not be explained by prevalence alone.

Clarity and hope for mental health, ADHD and autism

NHS Alliance’s mental health network, Rebecca Gray added: “This review offers much-needed clarity and hope. Clarity on the real rise in mental distress and the factors behind unprecedented demand for help for ADHD and autism, and hope, because many of the proposed solutions are already in train.

“The review strikes a welcome balance between strengthening prevention and early intervention while maintaining a clear focus on ensuring prompt access to high-quality specialist NHS mental health support.

“It is really encouraging to see that many of the recommendations are happening across different parts of England, with mental health providers in primary and secondary care, in the NHS and in the voluntary, community and social enterprise (VCSE) sector, increasingly offering support ahead of or complementing clinical care.”

Tips for clinical practice

Assess needs as well as symptoms: Consider functional impairment, daily living, mental health and the patient’s wider circumstances.
Recognise overlapping conditions: Autism, ADHD and mental health difficulties can coexist and require careful assessment.
Offer support while patients wait: Consider appropriate interventions and reasonable adjustments without making all support dependent on diagnosis.
Maintain diagnostic quality: Use established assessment pathways and be alert to incomplete or inconsistent diagnostic information.
Plan beyond diagnosis: Consider ongoing treatment, follow-up and multidisciplinary support, particularly for patients with complex needs.
Focus on meaningful outcomes: Assess improvements in functioning, participation and quality of life alongside clinical symptoms.

Alison Bloomer

Alison Bloomer is Editor of Pavilion Health Today. She has over 25 years of experience writing for medical journals and trade publications. Subjects include healthcare, pharmaceuticals, disability, insurance, stock market and emerging technologies.

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